Radtke FM, Franck M, Drews T, Weiss-Gerlach E, Twigg E, Harbeck-Seu A, et al. Am J Psychiatry. Spontaneous vertebral artery dissection (VAD) represents a rare but significant disease, accounting for an average annual incidence rate of about 0.97 to 1.5 cases per 100.000 population [1, 2]. All participants have given written informed consent. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Furthermore, PTSD was the single best predictor of patients mental QOL in their study. (2009) [6] prospectively found 3793455days after event 30% patients with impaired SS-QOL scoring among 66% with favorable functional outcome (mRS01) in a mixed series including patients with VAD and patients with ICAD. Plank position (but otherwise safe to participate in yoga or Pilates). Stroke. While SS-QOL at follow-up was normal and corresponded to pre-baseline in stroke mimics, SS-QOL scores significantly worsened in group D and I patients, mainly in the psychosocial domains. Cerebral ischemia in group I patients was caused by cardiac embolism in 34.2%, lacunar disease in 21%, large artery disease in 10.5% and by undetermined cause in 34.2% according to the TOAST-criteria [14]. The vertebral arteries have many small branches. The challenging main consequence from our study regarding this older age group of VAD patients might be therefore for the treating physician to make the right decision: When to consider (re-)dissection stroke and when to consider neuropsychiatric sequelae, for example. Theyll use contrast dye and X-ray-guided imaging to look at blood flow through the artery itself along with the extent of the dissection or vessel injury in real-time. These include vertebral and carotid arteries. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Adding one additional base point in all individuals our self-constructed cognitive composite score (CCS) showed a range from score 1=normal to 10=completely pathological. VAD leads to impaired QOL at 6months follow-up due to multiple factors. WebWhat is the life expectancy of someone with fibromuscular dysplasia? Correspondence to It comprised standardized self-rating protocols for neurostatus (mRS), stroke specific QOL and posttraumatic stress symptoms, and in addition open questions for the clinical course. Every pathological result, that is a value below one standard deviation, in one of the nine above mentioned cognitive function test domains was transposed to a cognitive composite score for each individual for the purpose of interindividual comparison. (2018) [38] reported more recently in their observational cohort study on patients with cervical, mainly carotid artery dissection, that numerically, but not statistically significant more patients with combined endovascular therapy (EVT)/intravenous thrombolysis (IVT) had excellent outcome and arterial recanalization than patients treated with EVT only. Spontaneous vertebral Differences in baseline or follow-up characteristics between the three groups (D, I, M) were analyzed with Chi-square tests for categorical and with Kruskal-Wallis-test (H-test) for metric variables. In a subsequent multiple regression analysis, neurocognition at baseline measured by MMSE, neurostatus at baseline measured by mRS and posttraumatic stress symptoms measured by PTSS-14 proved to be independent predictors for the quality of life at follow-up, explaining in combination 71% of its variance. Patients with suspected cervical artery dissection received additional angiography, mainly MRI angiography, if there has not been already evident cranial computer tomography or even conventional angiography. Evaluation for neurological status at baseline was done by the responsible physician at patients admission to hospital, using the National Institute of Health Stroke Scale (NIH-SS) [18], and by an experienced neurologist (RJS) at the time of neuropsychological testing, administering the modified Rankin Scale (mRS) [8]. Group-related mean values were below this cut-off level and not significantly different between groups: group D 27.1513.10, group I 23.848.74, and group M 26.129.55. Advertising on our site helps support our mission. Disabil Rehabil. Important non-vascular incidents were a newly diagnosed prostate cancer with radiation therapy in group D and an inpatient treatment for depression in one patient as well as a single epileptic seizure in another one in group I. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Vertebral artery dissection (VAD) is an increasingly recognized cause of stroke in patients younger than 45 years. This exploratory study was carried out in the Neurological Department of the University-affiliated teaching hospital AGAPLESION Diakonieklinikum Rotenburg, Germany. Toglia J, Fitzgerald KA, O'Dell MW, Mastrogiovanni AR, Lin CD. Complete data analysis of paired mRS and SS-QOL scores at follow-up was possible in all 33 surviving patients of group D but one who provided only incomplete SS-QOL data. In line with previously published and reviewed data [36], the rate of ischemic recurrence of 9% in our VAD patients (literature estimates between 0 and 13.3%) and rate of recurrent dissection of 3% (literature estimates between 0 and 25.0%) were low. Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Depending from the availability of imaging techniques such as magnetic resonance imaging (MRI) angiography as well as the awareness of physicians VAD has been increasingly diagnosed in recent years. 2013;80(6):78790. The method of evaluation, i.e. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. (1987) [33] and Wahlund et al. 2008;28(6):171128. Ischemic stroke was found in only 33.9%. The aim of this study If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. Blood thats not moving can form a clot, creating a bulge that disrupts blood flow. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. However, you may be at risk for future dissections. The most frequent localizations of cerebral ischemia were cerebellum and brainstem (medulla oblongata, pons or mesencephalon) in both groups, D with 47% each and I with 34.2 and 42.1%, respectively, without any significant group differences in the cell counts of Chi-square test. In case of significant difference, a subsequent analysis between two group pairs was performed: For categorical variables the Chi-square test or Fishers exact test, if appropriate, and for metric variables the Mann-Whitney U-test was used with Bonferroni-correction of cumulative alpha-error. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. Vertebral artery dissection (VAD) is a rare cause of stroke in the general population; however, represents one of the more common causes of stroke in patients younger than 45 years of age. 2011;134(Pt 12):367286. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Mean MoCA values of group D (24.24) and I (24.86), however, displayed slightly pathological scores. Likewise, in concordance with the literature [5, 6, 36], functional outcome was good (mRS02) in the majority of patients (81.25%). Vertebral artery dissection (VAD) may cause cerebral ischemia and impair quality of life (QOL) despite of good functional outcome. Previous studies described poststroke cognitive decline by global cognitive screening such as MMSE and more recently and more sensitively by MoCA [42]. The health-related quality of life after VAD was examined in a standardized manner for the first time in only two published studies [5, 6] in the last decade. No individual persons personal details, images or videos are being used in this study. Participants were examined for psychological, cognitive and neurological variables with special reference for functional outcome as well as quality of life 6months after the index event. 2017;88(14):131320. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). 2014;23(2):33542. Vertebral artery dissection: presenting findings and predictors of outcome. 2013;94(12):253541. Kwa VI, Limburg M, de Haan RJ. (2009) [6]. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. Differential features of carotid and vertebral artery dissections: the CADISP study. These are typically among the first tests people receive. Gttingen: Hogrefe Verlag; 1983. When starting the present study, however, the knowledge about the putative contributing role of cognitive as well as psycho-affective factors to QOL in VAD patients was lacking. In accordance with common convention, mRS score of 02 reflects a good functional status meaning independency in daily living. Traenka C, Jung S, Gralla J, Kurmann R, Stippich C, Simonetti BG, et al. 2018;265(8):18919. Thirty-one of 62 study participants completed 18.922.72months after discharge four tests of attention and memory function. Neurosurgery. Group D only displayed a significant lower mean value than groups I and M in the domain social roles. 2004;75(8):11946. 2002;13(3):1927. Finding Support, the Right Doctor, and Some Validation The months following that fateful workout session were a 2001;344(12):898906. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. Previous VAD studies mainly focused on classical outcome endpoints such as mortality and recurrence rate. We do not endorse non-Cleveland Clinic products or services. California Privacy Statement, (2014) [46]. Thomas LC, Rivett DA, Attia JR, Levi CR. It can also lead to swelling (dilation) of the artery. SS-QOL-subgroup analysis of patients with dissection and mRS score 02 at follow-up, SS-QOL Stroke Specific Quality Of Life; mRS modified Rankin Scale. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. 2006;67(10):180912. Neurorehabil Neural Repair. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. N Engl J Med. Vulnerability--a new view of schizophrenia. New York: Oxford University Press; 2006. Radiographics. GA compendium of neuropsychological tests. J Neurol. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Because previous studies have shown no crucial role of neurovascular risk factors or sociodemographic factors for QOL of VAD patients, we focused our analysis of potential contributing factors for QOL on previously less investigated neurological, neurocognitive and psychological variables with special respect to the biopsychosocial model [12]. Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. For more extensive testing, a neuropsychological test battery was used with cognitive tasks of nine cognitive domains with possible reference to cognitive functions of the anatomical structures of the posterior circulation, in particular the cerebellum. Stress revisited: a critical evaluation of the stress concept. Gttingen: Beltz Test GmbH; 2001. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. I ( 24.86 ), however, displayed slightly pathological scores of patients with dissection and mRS score 02 follow-up! Is an increasingly recognized cause of stroke in patients younger than 45 years 18.922.72months after discharge four tests attention. Previous VAD studies mainly focused on classical outcome endpoints such as MMSE more... 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